Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | ME102412 | FL |
NPI | 1053577015 |
---|---|
Provider Name | Dr. Keyne K Johnson |
First Address | Orlando, FL 32806-2947 |
Second Address | Orlando, FL 32806-2947 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2008 |
Last Update Date | 15/09/2016 |